CVS Health
Utilization Management Physician Reviewer
$230K
Chicago-525 West Monroe · Remote · Full-time · Posted Oct 14, 2026
- Experience
- At least 1 year of Utilization Management experience for Medicare and/or Medicaid; 3–5 years of clinical practice in a primary care setting.
- Education
- M.D. or D.O. degree from an accredited medical school.
About the job
Reviews inpatient and outpatient service requests and makes timely coverage determinations using utilization management criteria, clinical judgment, and organizational policies, while coordinating with care teams to support appropriate patient care.
What you'll do
- Review service requests, document decision rationales, and make utilization management determinations.
- Coordinate with transitional care and primary care teams and participate in patient panel discussions as required.
- Maintain compliance with regulatory, accreditation, and payer requirements; contribute to utilization management improvement efforts.
What they ask for
- At least one year of Utilization Management experience serving Medicare and/or Medicaid.
- Current, unrestricted U.S. medical license.
- M.D. or D.O. from an accredited medical school.
- U.S. work authorization.
Pay
$230k per year (salary; basis not specified); $83.69 - $180.25 USD (base hourly rate or base annual full-time salary, as stated)
Tools
CMS, MCG
Model-written summary · the original posting is authoritative